Hill, Luna 84442C

;a1* FjOAST4,& ❑ CAMA [I DREDGE & FILL N9 84442 A B C D
y GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (� )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ cW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body i ,' (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body %7^
ORW: yes/no PNA: yes/no
Type of Project/ Activity �� �Ii `, i i ���� Zf t"�D, i fi- c. >'V tri i, t. % k
2 eir i't (Scale: �+✓ice
Shoreline Length � _ e
I __ i - I
Access Length ----r - 3_W __�.� � _ �... �_._ _.._'_. _ ...- -
i
Pier(dock)length
Fixed Platform(s) j
Floating Platform(s)
Finger pier(s) _
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attachec
A building permit/zoning permit may ue requirea ny:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date
Expiration Date

!�°``°"�'�&EICAMA [I DREDGE & FILL N9 84442 A B c D
y GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification [:]Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)_
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attache(
A building permit/zoning permit may be required by:
Permit Conditions
(Scale:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

do AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: o c G'
Mailing Address:
Phone Number:
Email Address: --
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
��ZLIao
in ��— County.
`7) C- 02 o S l 1
600g-t- Z�&'6tioaL ea','
1 furthermore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
,L cj'< a. �� /-/e f 91 11
Print or Type Name
Title
�1—& 6' / J,/) -� / RECEIVED
Date
JUN 2 2 2022
This certification is valid through Q /_I---a-L-1 J42 3 DCM-MHD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner.
Address of Property:
Mailing Address of Owner: 1X1 1V)11-19-16e11,
Owner's email:
e -.2
Owner's Phone#: S -
Agent's Name: 4&.rr 94� Agent Phone#: o1.S-1 - 24 :�-- /2y
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawino, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557, DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
4
I DO wish to waive some/all of the 15' set�k* �G%2
Sighature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Ripari�
'< Typed/Printed name of ARI
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
s l
Date: �`��� l rl
Waiver is valid for up to otAnitI RPO's Signature*
Revised May 2021
JUN 22 2022
'l c s/
tAd-
OCM-MHD CITY

41
Portion to
Narj)o rrt rlet i I } ay or tI,jeir gent)
r� f �: Owner:
+� { _
of 'rCpert
Address
2xe1r' email;
tint r :7 f�tinr�e�t'LIE 1611
Agent's Name;
t Aitz rat
gem's Er��� i.
AOJAC N7 RIPARIAN PROPEWrY OWNER'S CERTIFICATION
f_ -0tMt to-f$on to 4r� A 01 c�2 i t�rr cs afa zr,
I hereby certify that I own property adjacent to the above refetV reed property. The imiliuidual applylfig for this
Pefrf gas described to rn1e; as Shown can the attached tle°awing, the d velor�iieerkt they are proposing rA
titer§ Y�r dr in P{t dt t riSiClr1S F?1LA t b S, yiCj q th his Lm er
... „. I DO NOT have trjoje$:'(is to tf#du �33C'e��., .y.�s... , f �.,�f.. - �., �l�'j�':,Jtl�ii `.a '4iD at`31a �'��'-ri)�`'t°id"-',i.
VOU ,: ove object Otis w What is being ptopjssed, you r>a��z ri��4� Y the�t.�. Division of Coastal
$ :ylhi�,JMkwt mi in Wriiirt V,ri f 10 days, of r ceipf of this police, Cotrespondence Should be
M rloti to 400 Commerce Ave., Morehead City, NC 285,57, DCPArepresentatives can otso%e contacted
e�,j � � -. . N ra pers-se is con irietod f4a s��n no �. pct�lon l you l ave, heaa�`r��atlfleol b
WAIVER SE -IN
.p e dO ck, mooring ilillg6 0 t Avg . 3i-*�ik�i�iale o tnek. i 3
# dlvfe'`itl 3t ,. ri3i accc s 't9illL
» qy�
d ��3ip re tr its , �i ,. rs UC t
Ve rte df ycm Ive the se' 2. , ,
Signature r
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10 r I��rI r i
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TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION I WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or certified mail return
receipts (showing deliveryof notice) are needed, or any other method which satisfies the Local Permit Officer
(LPO) that a good faith effort has been made to provide notice.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DCM or the LPO an opportunity to consider these comments/objections before a permit decision
is made. "Permission" of adjacent property owners is not necessarily. required for DCM to issue a permit;
however, permission must be obtained for certain types of proposed developments if they fall within a 15'
setback area along the riparian access area of the adjacent property, as determined solely by DCM. It is in
the applicant's best interest to provide comprehensive and accurate notice so that any concerns or objections
can be resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals
the permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders? Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street -ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals (or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: hti s:/'/lr/ww.sosnc.,qov/searchiindex,'co.rp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
REC IVV-
1 G " 2 '. Revised May 2021
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